How to Avoid Unexpected Medical Bills: Expert Advice on Plan Care, Pricing and Health Records

An unexpected medical bill can be a very costly experience. Experts are sharing their advice on how to avoid the situation by being aware of network coverage, knowing what your insurance plan covers and maintaining health records. Follow these simple steps to lower your healthcare costs.

Choose Wisely

Surprise bills usually occur because of discrepancies between in-network and out-of-network providers. The American Hospital Association says you should find out which providers are in your health plan’s network before making an appointment.

Cover Yourself

According to the Texas-based company Right Medical Billing, it’s important to “figure out what your plan covers. A clearer understanding will help you prevent surprise medical expenses, and always contact your insurer to confirm coverage of a procedure.”

Know the Code

To ward off any surprises, confirm the “current procedural terminology” or “CPT code” before a procedure. “Third party payers and insurance companies think in terms of billing codes as opposed to procedure names,” says Dr. Todd Thames, VP of clinical affairs at Included Health, a virtual primary care provider. With the code, “you can run it by your insurer to confirm if they cover the service.”

Price It

Before you get surgery, treatment, a test or an exam, “find out from your insurer, the doctor and/or hospital what the costs are and how the facility you visit impacts the price,” explain the folks at Medicare. “Understand your insurance policy and the medical costs and services that are covered, including how much your plan’s deductible is and how it works.”

For the Record

Per the experts at Insure.com, it’s important to “maintain thorough health records. That includes planning and collecting data. Before the procedure, see if you can get a detailed cost estimate from the hospital or provider. You’ll want this information if you get a surprise bill and have to appeal.”